Form for Renewal of Scholarship for Post-graduate /4th Year of Engineering and

Medical studies under Central Sector Scheme of Scholarship for College and University

Students of Department of Higher Education

RENEWAL APPLICATION FORM
MHRD, DEPARTMENT OF HIGHER EDUCATION, GOVT OF INDIA, NEW DELHI

1.

Name of the Student

2.

Father's Name

3.

Address of the Student

4.

E-maiiiD &
Telephone/Mobile No.

Name of the Board from which class 12

exams appeared, year of passing,
percentage & Roll No.
6.
Name of Institute/college & course at
graduation level
7. Name of Degree/PG Course/4'h year of
Engg. & Medical
8. Name & Address of the College/Institute
from where completed degree course.
9.
Name & Address of the College/Institute
where the candidate is studying now
10. Admission No.

5.

11. Scholarship ID No.

12. No. of Scholarships received at
Graduation level studies.
13. Whether any other scholarship being
received by the student.
14. Name of the bachelor degree/ PG

Degree Course:
a)
Whether promoted to next class
b)
1" Year% of marks
2"' Year %of marks
c)
3'' Year% of marks
d)
15. %of Attendance

Yes

lNo

16. Remarks Regarding discipline of the

student, including ragging, etc.
17. Online facility Bank A/c Particulars of
the Student.
a) Bank Name
b) Account number
c) IFSC Code
d) Bank Code
e) Bank Address

..

Cert1f1ed that the particulars g1ven above are true:

*Mandatory
Signature of the Principal/Head
Of the Institute with College Seal

1) Scholarship ID No. as provided in final selection list is to be filled

compulsory without which renewal scholarship cannot be sanctioned.
2) This form has to be sent as early as possible to the State Education Board
duly verified by the Institute/College.
3. CISCE Students can send their Renewal forms to The Director (National
Scholarship) Ministry of Human Resource Development, Government of
India, Department of Higher Education, West Block-1, Wing-6, 2"' Floor,
Rama Krishna Puram, New Delhi-110066.

4. Further information of MHRDCSS Scholarship is available at website:

www .mhrd .gov .in